Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Access to care in a patient-centered medical home

Fred N. Pelzman, MD
Physician
September 28, 2013
Share
Tweet
Share

What does access to care look like in a patient-centered medical home?

To answer this we first have to see what access looks like now, under our current system.

What happens now?

A patient wakes up in the morning with abdominal pain, cannot reach us, and so turns to the computer and types “abdominal pain” into Google. He or she is rewarded with multiple catastrophic and deadly diagnoses, most of which they assume they have. As frustration over not being able to reach us or be seen builds throughout the day the patient is more and more convinced they need a CT scan or MRI to rule out this impending terminal outcome.

This is not an unusual scenario. Have you ever tried to reach your doctor before office hours or, even worse, during office hours? At night a reliable answering service is available; during the day can be another matter altogether. Most frustrating of all may be during the day when the answering service picks up because the staff has signed out to them early or for a long lunch. You know they’re there, but you just can’t reach them.

I can’t even get my own office on the phone, and I know who’s sitting at which desk, and I know all the secret backdoor numbers to try.

Phones ring endlessly, go to endless queues, computerized telephone trees that take you nowhere, and after someone finally answers, you can be placed on hold to listen to an entire opera before a live person returns.

Even if phones are picked up promptly by a real person, there’s no guarantee the patient can get the physician’s attention.

In the morning when I arrive at work I don’t have time to check my email or voice mail, because my first four patients are already here and waiting.

The in-basket of my EHR is full of various different types of messages I need to check (patient advice, refill request, appointment request, non-urgent message for the ractice). Often patients routinely ignore the admonition not to leave a message here saying they are having abdominal pain and need to speak with someone urgently.

Models of advanced access, including patient-controlled scheduling, have been tried with variable success. There’s something to be said for having a patient able to put themselves directly on a provider’s schedule, but it may not truly be the best way to get this done.

How can it work at its best?

If I or a member of my team can be reached, we may be able to talk them through it, listen to their symptoms and concerns, elicit a more detailed history, and possibly give them something to try (some Pepto-Bismol or TUMS) and then check back with them later. Or even offer an urgent same-day appointment in the practice.

I can’t be there 24 hours a day, 7 days a week; none of us can. We need to build a system that gives patients access to safe and effective healthcare, while preventing the unnecessary emergency room visits they turn to when they’re fed up with being unable to reach us or be seen.

We need to make specialists and subspecialists more accessible as well. And imaging and procedures. No one’s appointments should be considered too precious to be available in a more timely fashion when it benefits patients and creates better care.

ADVERTISEMENT

My patients are constantly told that someone can’t see them or they cannot get a test done for 2 or 3 months, when undoubtedly there’s really more availability for more urgent care than this.

Maybe in the future even the subspecialists will have their schedules wide open for access by a practitioner who has assessed the patient and found them wanting of that doctor’s care.

In our academic faculty practice, there are additional challenges facing access due to the fact that we are not always there and available. There are days when we have administrative responsibilities, sessions or even whole days where we are not seeing patients because we are supervising residents in their practice.

Similarly, the residents are not always available because of the extra time spent in education sessions while on ambulatory block, or the time away from their practice on inpatient rotations.

But by taking advantage of advanced access, improved ways to reach providers, use of more midlevel providers for triage and interim care, and expanded team coverage, we can only continue to improve on the current poor system of access that no doubt gives our patients more abdominal pain that what they woke up with this morning.

Fred N. Pelzman is an associate professor of medicine, New York Presbyterian Hospital and associate director, Weill Cornell Internal Medicine Associates, New York City, NY. He blogs at Building the Patient-Centered Medical Home. 

Prev

What Obamacare means to my family

September 28, 2013 Kevin 68
…
Next

Using Skype for patient visits: A doctor is sanctioned

September 29, 2013 Kevin 10
…

Tagged as: Primary Care

Post navigation

< Previous Post
What Obamacare means to my family
Next Post >
Using Skype for patient visits: A doctor is sanctioned

ADVERTISEMENT

More by Fred N. Pelzman, MD

  • Why electronic medical records should be standardized

    Fred N. Pelzman, MD
  • Can answers to after hours calls be automated?

    Fred N. Pelzman, MD
  • We have to do better than DNR tattoos

    Fred N. Pelzman, MD

More in Physician

  • How New Mexico became a malpractice lawsuit hotspot

    Patrick Hudson, MD
  • Why compassion—not credentials—defines great doctors

    Dr. Saad S. Alshohaib
  • Why Canada is losing its skilled immigrant doctors

    Olumuyiwa Bamgbade, MD
  • Why doctors are reclaiming control from burnout culture

    Maureen Gibbons, MD
  • Why screening for diseases you might have can backfire

    Andy Lazris, MD and Alan Roth, DO
  • Why “do no harm” might be harming modern medicine

    Sabooh S. Mubbashar, MD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
    • How fragmented records and poor tracking degrade patient outcomes

      Michael R. McGuire | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How I learned to stop worrying and love AI

      Rajeev Dutta | Education
    • Understanding depression beyond biology: the power of therapy and meaning

      Maire Daugharty, MD | Conditions
    • Why compassion—not credentials—defines great doctors

      Dr. Saad S. Alshohaib | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
    • How fragmented records and poor tracking degrade patient outcomes

      Michael R. McGuire | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How I learned to stop worrying and love AI

      Rajeev Dutta | Education
    • Understanding depression beyond biology: the power of therapy and meaning

      Maire Daugharty, MD | Conditions
    • Why compassion—not credentials—defines great doctors

      Dr. Saad S. Alshohaib | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Access to care in a patient-centered medical home
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...